Billing in Tobacco Use Disorder

Billing in Tobacco Use Disorder

 

  • As of January 2011, Medicare covers face to face tobacco cessation counseling from a Medicare recognized practitioner (physician, physician assistant, nurse practitioner, clinical nurse specialist, qualified psychologist or clinical social worker) for all Medicare patients.

 

Two G codes are used for which Medicare will waive the deductible and coinsurance/copayment (Note: Routine screening is not covered):

G0436:

    1. Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes

 

  1. Short Descriptor: Tobacco-use counsel 3-10 min.

 

G0437:

    1. Long Descriptor: Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

 

  1. Short Descriptor: Tobacco-use counsel >10 min.
    • Two attempts per year are covered, but each attempt can take four sessions.

 

    • Applies to services under Medicare Part A and Part B.

 

    • Medicare part D still covers physician prescribed smoking medications (varenicline and, for some plans, nicotine nasal spray or inhaler with prior authorization, step therapy, and quantity limits).

 

  • Inpatients are covered if tobacco use is not the primary reason for their hospitalization as long as they are alert and competent.

 

 

What Documentation to Include?

    • Time spent on the counseling

 

    • Type and quantity of tobacco used

 

    • Counseling provided and any prescriptions/therapeutic recommendations (e.g., “Advised patient to quit and described risk of continued tobacco use”)

 

  • A medical condition is no longer required to treat tobacco use disorder.

 

CPT Tobacco Cessation Codes

CPT Codes Description Fees
99406
    • Smoking and tobacco-use cessation counseling visit; intermediate/ E/M counseling service; greater than 3 minutes up to 10 minutes, two to three sessions.

 

  • Short descriptor: Smoke/Tobacco counseling 3-10. Note: 1 session, less than 3 minute sessions, are not reimbursed by Medicare.
$10-15
99407
    • Smoking and tobacco-use cessation counseling visit; intensive E/M counseling service; greater than 10 minutes, four sessions.

 

  • Short descriptor: Smoke/Tobacco counseling greater than 10
 $25-30

 

S9075
  • Smoking Cessation Treatment
S9453
    • Smoking Cessation Classes, non-physician provider, per session Various Evaluation and Management Services (associated with acute or chronic care).

 

  • When providing an E/M service, if greater than fifty percent of face-to-face time with patient is spent in counseling, time may be used as a basis for selection of level of service.
99381-99397
  • Preventive medicine services
96150-96155
  • Health & Behavior Assessment/Intervention (Non-physician only)
99078
  •  Physician educational services in a group setting

 

Source:

1. American Academy of Family Physicians. HCPCS, CPT, & ICD-9 Codes Related to Tobacco Cessation Counseling. AAFP.org. 2011.

(Available at: http://www.integration.samhsa.gov/images/res/Coding-list.pdf )

2. University of Wisconsin Center for Tobacco Research & Intervention (UW-CTRI). International Classification of Diseases (ICD) – 10 Codes Tobacco/Nicotine Dependence, and Secondhand Smoke Exposure Effective October 1, 2015. . 2015.

(Available at: http://www.ctri.wisc.edu/documents/icd10.pdf)

3. SBIRT CORE Training.

(Available at: http://www.sbirttraining.com/)

 

 

Please do post your questions or comments below. 


Dr. Harvinder Singh, M.D. (Admin)


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